Patient history : A 71-year-old woman attends the emergency department with a severe nosebleed. The bleeding started an hour before and is causing the patient a great deal of distress. She is not known to have any bleeding abnormalities. Previous medical history includes hypertension, angina, and hypercholesterolemia. She takes aspirin 75 mg od, bendrofluazide 2.5 mg od, isosorbide mononitrate 30 mg bd and simvastatin 40 mg nocte. She has no known allergies, and she is an ex-smoker.
Physical examination : Her blood pressure is 172/103 mmHg, and her pulse rate is 91/min. The oropharynx appears normal, with no evidence of blood draining in the posterior pharynx. Inspection of the nasal cavity using a speculum and light source suggests a bleeding point from the left nostril. There are no masses seen, and there is no palpable cervical lymphadenopathy. The cardiovascular and respiratory…
